The palmaris longus (PL) muscle is characterised by high morphological diversity, and its tendon crosses the median nerve (MN) at different levels. Due to the fact that the palmaris longus tendon is routinely harvested for reconstruction of other tendons, knowledge of its morphological variations is clinically important. Therefore, the purpose of the study was to suggest a new morphological classification of the PL muscle and characterise the relationship of its tendon to the median nerve.
Methods
Standard dissection was performed on 80 randomised and isolated upper limbs (40 left and 40 right) fixed in a 10% formalin solution. Measurements of muscle belly and tendon were obtained. The course and location of tendon insertion, as well as its relationship to the median nerve, were noted.
Results
The palmaris longus muscle was present in 92.5% of specimens. Three types of palmaris longus muscle were identified based on the morphology of its insertion (types I-III) and these were further subdivided into three subgroups (A-C) according to the ratio of the length of the muscle belly and its tendon. The most frequent was type I (78.8%), where the tendon attached to the palmar aponeurosis, and subtype B, where the tendon-to-belly ratio was 1–1.5 (41.1%). The mean distance from the interstyloid line to the crossing between the median nerve and the palmaris longus tendon was 31.6 mm. In addition, two types of palmaris longus were described.
Conclusion
The presented classification of palmaris longus muscle types allows a better characterization of its diversity and may be useful in planning tendon grafting.
The sacroiliac joint is a diarthrodial synovial joint in the pelvis. Anatomically, it is described as a symphysis, its synovial joint characteristics being limited to the distal cartilaginous portion on the iliac side. It is a continuous ligamentous stocking comprising interconnecting ligamentous structures and surrounding fascia. Its ligaments, the primary source of its stability, include the anterior, interosseous and dorsal sacroiliac, the iliolumbar, sacrotuberous, and sacrospinous. Structural reinforcement is also provided by neighboring fascia and muscles. Lower back pain is a common presentation of sacroiliac joint disease, the best-established treatments being corticosteroid injections, bipolar radiofrequency ablation, and sacroiliac joint fusion.
The pronator teres (PT) muscle is a forearm flexor with radial and ulnar heads. It is innervated by the median nerve (MN), which passes between these heads. Nerve entrapment, known as “PT syndrome”, may occur in this passage. Anatomical variations in this region may be potential risk factors of this pathology. Therefore, the aim of the study was to determine the relationship between morphologic variations of the PT and the MN. In 50 isolated, formalin-fixed upper limbs, the cubital region and the forearm were dissected. The following measurements were taken: origin of the PT muscle heads, the length of these heads, the length of the forearm, diameter of the MN and the number of its muscular branches to the pronator teres muscle. The forearms with the humeral head originating from the medial humeral epicondyle and medial intermuscular septum (72%) were significantly shorter (p = 0.0088) than those where the humeral head originated only from the medial humeral epicondyle. Moreover, in these specimens, the MN was significantly thinner (p = 0.003). The ulnar head was present in 43 limbs (86%). The MN passed between the heads of the PT muscle (74%) or under the muscle (26%). In the majority of cases, it provided two motor branches (66%). There is an association between the morphologic variation of the PT muscle heads and the course and branching pattern of the MN. Both are related to differences in forearm length. This may have an impact on the risk of PT syndrome and the performance of MN electrostimulation. 相似文献
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